Provider Demographics
NPI:1598851396
Name:KLIPPER, DAVID M (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:KLIPPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 NE SISKIYOU ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1161
Mailing Address - Country:US
Mailing Address - Phone:503-233-0649
Mailing Address - Fax:
Practice Address - Street 1:4231 NE SISKIYOU ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1161
Practice Address - Country:US
Practice Address - Phone:503-233-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO24734174400000X
ORD0247342085R0202X
GA0666932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA066693OtherPHYSICIAN LICENSE
OR232505Medicaid
ORH69032Medicare UPIN
ORR132105Medicare PIN
ORR179328Medicare PIN
OR232505Medicaid